October 4, 2012

Almost half of HCV infections and more than 20% of HBV infections may go undiagnosed among people with comprehensive health care, according to a recent study

In an observational cohort study, researchers evaluated data from 867,589 members of four health care organizations (HCOs) throughout the United States between January 2006 and December 2008 who had one or more clinic visits and at least 12 months of continuous follow-up. This cohort included 866,886 participants with no previous HBV-related diagnoses and 865,659 with no prior HCV-related diagnoses. Investigators compared the number of infections reported in the cohort with a projected number based on National Health and Nutrition Examination Survey (NHANES) data.

Among patients who had no prior HBV diagnosis, 18.8% underwent HBV testing, with positive results seen in 1.4% of cases. Among those with no previous HCV diagnosis, 12.7% were tested, with 5.5% testing positive. Estimates from NHANES data indicated that at least 43.1% of those with HCV and 21.1% of those with HBV in the cohort had not been tested or diagnosed.

HCV infection was more common among patients aged 50 to 59 years (adjusted OR=6.04, 5.38-6.77, compared with patients younger than 30 years), while positive HBV test results were significantly more common among Asian (adjusted OR=6.33, 5.53-7.24) and Hawaiian/Pacific Islander (aOR=3.64, 2.99-4.42) patients than white participants (95% CI for all).

Among 65,778 patients with two or more elevated alanine aminotransferase ( ALT) levels, 42.2% were tested for HBV (1.7% positive), and 43.9% were tested for HCV (8.2% positive). These patients were more likely to test positive for HBV (aOR=2.16; 95% CI, 1.58-2.96) or HCV (aOR=2.96; 95% CI, 2.54-3.45).

“Even in these HCOs, which provided comprehensive care, many who had two or more elevated ALT levels were not tested for HBV and HCV infection,” the researchers wrote. “Although implementation of the health care reform legislation of 2010 may improve access to care, more aggressive policies in hepatitis testing to identify all infected persons are warranted.”

ABSTRACT

Aim To explore the facilitators of long-term hepatitis C avoidance among people who inject drugs.

Design We employed a qualitative life history design.

Setting Recruitment took place through low-threshold drug services and drug user networks in South East and North London. Participants were interviewed at the recruitment services or in their homes.

Participants The sample comprised 35 people who inject drugs, 20 of whom were hepatitis C antibody-negative. Participants' average injecting trajectory was 19 years (6–33), with 66% primarily injecting heroin, and 34% a crack and heroin mix. Nine (26%) of the sample were female and the average age was 39 years (23–53).

Measurements Two interviews were conducted with each participant, with the second interview incorporating reference to a computer-constructed life history time-line. Interview accounts were audiorecorded, transcribed verbatim and analysed thematically.

Findings Hepatitis C risk awareness was recent and deprioritized by the majority of participants. The facilitation of venous access and care was an initial and enduring rationale for safe injecting practices. Difficult venous access resulted in increased contamination of injecting environments and transitions to femoral injecting. Participants expressed an unmet desire for non-judgemental venous access information and advice.

Conclusions Harm reduction interventions which attend to the immediate priorities of people who inject drugs, such as venous access and care, have the potential to re-engage individuals who are jaded or confused by hepatitis C prevention messages.

By now, the overwhelming seroprevalence and high seroincidence rates of hepatitis C virus (HCV) among people who inject drugs (PWID) should have convinced policy makers to dowhatever they can to increase syringe access. Foremost among health programs aimed at PWID should be to shift the emphasis of prevention messages from discouraging syringe and ancillary paraphernalia sharing to encouraging PWID to use only a new, sterile syringe. The evidence that syringe re-use facilitates HCV transmission even when PWID use their own previously used syringe to inject is overwhelming. Studies have demonstrated the survival of HCV virus in syringes [1] and shown how the use of a previously used syringe can contaminate shared drugs and/or injection paraphernalia (water, cottons or drug mixing containers) that others may use [2,3].

Finding ways to limit syringe use to a single injection requires interventions capable of reaching PWID who may have grown immune to public health dictates, and become indifferent about a virus that seemingly few avoid. As Harris & Rhodes explain, interventions based on informing PWID about their ‘deficits in risk knowledge and avoidance’ may be seen as condescending and act to further alienate PWID, particularly those already infected with HCV [4]. Such messages reflect a predominant HCV prevention research and intervention model that focuses too narrowly on injection risk behaviours and emphasizes individual behavior change and responsibility while ignoring the complex interplay of situational and relational factors that influence risk [5–11]. Injection risks become decontextualized and ahistorical, resulting in interventions that are ineffective.

Harris & Rhodes challenge this perspective by employing a qualitative research study based on life histories to explore how PWID, the majority of whom were longtime injectors and HCV antibody-negative, avoided HCV. They found that participants were not particularly concerned with HCV; rather, the primary motivation for not re-using syringes reported by the 11 participants who had injected for 20 years or more and were still HCV antibody-negative was that new syringes were sharp, not that they were sterile.

As described in excerpts from participants’ narratives, PWID have good reasons besides the threat of HCV transmission for preferring sterile syringes. Sclerosis of peripheral veins is endemic among long-term injectors, and attempting to inject with a used syringe is often painful and protracted. That PWID may be more motivated to use new sterile syringes to protect their veins and minimize the pain and anguish that comes from repeatedly trying to jab blunt needles into this ever-diminishing venous resource should not surprise researchers who have observed drug injection and listened as PWID describe it. Bourgois & Schoenberg’s recent ethnography of a group of homeless PWID in San Francisco, Righteous Dopefiend [5] examines graphically the brutal consequences of long-term injection on the body through fieldnotes, photoethnography and analysis. They describe observing men as they stab themselves repeatedly for as long as 45 minutes, searching for a vein in which to deposit their heroin. They also show, visually and through text, the suffering caused by abscesses, an all-too-frequent corollary of skin popping, or injecting into fatty tissue when one’s veins are no longer usable. What is surprising is that this degree of suffering has continued unchecked even though it has been observed and documented for decades.

Harris & Rhodes call attention to this everyday suffering, and suggest making venous care a central theme of interventions, thus shifting the direction of harm reduction research and intervention from ‘a focus on risk and deficit to one that attends to the protective practices and short-term concerns of PWID’ [4]. They suggest countering PWIDs’ apparent lack of interest in messages emphasizing risk behavior mechanics and their avoidance with messages that instead recognize and focus upon more immediate health concerns, in particular PWIDs’ interest in preserving peripheral veins, avoiding painful injections and lessening the need to resort to groin (femoral vein) and neck (jugular vein) injecting. As the authors explain, these goals are best achieved through the use of new sterile needles—an outcome that also addresses the more abstract threat of HCV transmission.

The shift envisioned by these authors builds upon previous work and implies a redirection in current HCV prevention strategies, from risk and its avoidance towards vulnerability and its alleviation. As such, it implies a concomitant commitment to expanding structural level interventions—changes in ‘the context within which health is produced or reproduced’ [12] as well as increased access to health-care services and sterile syringes. As a recent meta-analysis by Turner et al. suggests, high-coverage syringe distribution—where PWID obtain a sufficient number of needles to cover their injection frequency—can reduce HCV transmission [13]. Combining health-affirming messages with the material resources necessary to relieve the immediate and ongoing injuries of injection may prove to be important both for reducing the HCV epidemic among PWID and for demonstrating the utility of a prevention research and intervention approach based on a more comprehensive understanding of their concerns.

A deadly virus has gripped people battling a more serious disease of poverty. Down with hepatitis C, more than 1,600 poor people in Baghapurana, 600 in Langeana village, 900 in Badhni Kalan town and many more in the surrounding areas in this district are in a lonely struggle.

Instead of installing hepatitis-test facilities at the civil hospitals of Baghapurana, Badhni Kalan and Nihal Singh Wala, the health department has tried to cover up the epidemic. Its survey teams recorded only 87 cases of the disease. "The survey was an eyewash and done in haste for the sake of filing a report," said Charanjit Sharma, a teacher at Langeana, a worst-affected village that no team ever visited.

The ruling Shiromani Akali Dal (SAD) had made an election promise of solving Moga's 10-year-old hepatitis-C problem, recalls social worker Gurtej Singh Brar of Langeana. "Where's the solution?" said Charan Singh of Baghapurana, former subedar in the army.

Gurtej Singh, 35; Jagmohan Singh, 39; Nirmal Singh, 22; and Resham Singh, 32, all of Langeana found out they had hepatitis when they went to donate blood at a camp in their village. That was three years ago. "In the past 10 years, the health department has never organised any camp for the hepatitis-C examination," said Gurtej Singh.

Five people from two poor families of Sukhanand village visit a baba (witch doctor) every Sunday to get rid of the curse. "We have no money for treatment," said Malkit Kaur, one of the people seeking relief. "My husband, a farm labourer, makes Rs. 1,500 a month. We are a family of six; how can my two sons and I get any medicine for hepatitis-C from any private hospital."

Additional deputy commissioner Joram Beda accepted the seriousness of the situation. "The health department does hold examination camps from time to time," he said. "Many private doctors, however, do not report all the hepatitis cases to us. I will seek a detailed report and do investigation."

Dangerous and illegal claims have been made by some widely sold nutritional supplements. Findings by a new federal report today say dozens of weight-loss and immune system supplements are illegally labeled and lack scientific evidence for their health claims. The Department of Health and Human Services’ inspector general found that 20 percent of the 127 weight-loss and immune-boosting supplements investigators purchased online and in retail stores across the country carried labels that made illegal claims to cure or treat disease. It’s a scathing indictment of a booming $20 billion industry. Some products said they could cure or prevent diabetes or cancer or help people with HIV or AIDS, which is strictly prohibited under federal law. The report says consumers may not just be wasting their money on pills or tablets, but could be endangering their health if they take a supplement in place of a prescription drug. “Supplements that make disease claims could mislead consumers into using them as replacements for prescription drugs or other treatments for medical conditions, with potentially dangerous results.”

The Harlem woman who is suing a Brooklyn clinic over an unauthorized HIV test also claims her results weren't kept confidential and that another staff member suggested she get retested. (Peter Dazeley/Getty Images)

Harlem woman claims doctor violated law by giving her test against her wishes and gave her result without mandated counseling. She seeks damages for 'terror, confusion, embarrassment and emotional distress.'

AIDS advocates from AHF and other groups around the US protest Gilead for its $28K price of the HIV drug, Stribild and CEO John Martin's $54M earnings at the 2012 U.S. Conference on AIDS in Las Vegas. (Photo: Business Wire)

October 03, 2012 10:10 PM Eastern Daylight Time

Advocates target Gilead with three days of protests and actions at United States Conference on AIDS (USCA) over steep price of Gilead’s latest AIDS treatment, Stribild, at $28,000 per patient, per year while CEO John Martin earned $54.5 million in his most recently reported compensation, landing him 10th on Forbes’ List of highest paid U.S. CEOs

LAS VEGAS--(BUSINESS WIRE)--AIDS protesters and advocates targeted Gilead Sciences and its CEO John Martin with three days of protests and actions at the United Stated Conference on AIDS (USCA) in Las Vegas over the steep pricing of Gilead’s latest AIDS treatment, Stribild—priced at $28,000 per patient, per year in early September after FDA-approval of the drug—which came on the heels of the news that CEO Martin earned $54.5 million in his most recently reported annual compensation from Gilead, an amount that landed him tenth on Forbes’ List of highest paid CEOs in the United States. Martin joined CEOs for Disney, Occidental Petroleum and Starbucks in an elite club of top executive earners.

AIDS Healthcare Foundation (AHF) spearheaded the protests at the conference, which ends today and according to the website of conference host, the National Minority AIDS Council (NMAC), “…is the largest annual AIDS-related gathering in the U.S., bringing together thousands of workers from all fronts of the HIV/AIDS epidemic—from case managers and physicians, to public health workers and advocates, people living with HIV/AIDS (PLWHAs) to policymakers—to build national support networks, exchange the latest information and learn cutting-edge tools to bring an end to the HIV/AIDS epidemic.”

“On Sunday we effectively shut down the Gilead booth that was promoting Stribild when we surrounded it, chanting and doing a ‘die in.’ The response from conference attendees was pretty positive, as many of them photographed the action and took the John Martin $1,000 bills that we handed out. We had some attendees join in our protest holding signs and chanting with us,” said Joey Terrill Director of Community Mobilization for AIDS Healthcare Foundation. “On Monday, we changed our strategy protesting and returning after twenty minutes or so effectively ‘chasing’ playing this ‘cat-and-mouse’ game. We also marched with signs around their other booth, which was not Stribild-specific, spreading out our advocacy action to another central location in the exhibition hall. All this was part of our overall effort to highlight and shame Gilead for the huge wealth that John Martin is accumulating by gouging government programs—the largest purchaser of pharmaceuticals—for their AIDS drug pricing and policies exemplified by the astronomical $28,000 price of Stribild.”

Each day at the protests, AHF’s Terrill dressed as John Martin wearing a mask with his likeness. Terrill was joined by dozens of others from AHF and other AIDS groups around the U.S. at the actions sporting a mix of handwritten signs, banners with the $1,000 John Martin bill and handing out smaller versions of the bill with information about the group’s concerns printed on the back.

“It’s outrageous for Gilead’s CEO to be one of the highest paid executives in the nation, making tens of millions of dollars by selling lifesaving medications at such high prices that more than 2,000 Americans in desperate need of medications cannot access them,” said Michael Weinstein, AHF’s President. “People living with HIV/AIDS, their families, friends and communities should be up in arms over this sort of corporate greed in the face of life-or-death need. So too should taxpayers, who are almost directly responsible for placing wads of cash in Martin’s pockets. It’s the taxpayers who foot the bill for government health care programs—like state AIDS Drug Assistance Programs—a significant contributor to Gilead’s profit margin.”

AIDS Healthcare Foundation (AHF), the largest global AIDS organization, currently provides medical care and/or services to more than 183,000 individuals in 27 countries worldwide in the US, Africa, Latin America/Caribbean, the Asia/Pacific Region and Eastern Europe. To learn more about AHF, please visit our website: www.aidshealth.org, find us on Facebook: www.facebook.com/aidshealth and follow us on Twitter: @aidshealthcare.

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